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Informed consent & the animal guessing game

Growing up in Canada, my family spent a lot of time in the car. While my European friends would tell me how they could drive through 4 countries in a matter of hours, in Canada I couldn’t get part of the way through our smallest province in the same time period. Canadians have to travel long distances to get anywhere, which is part of the reason why they’re such a tolerant and patient lot.

So on these long drives (long before the days of portable entertainment devices) my family would have to think of ways to pass the time. Our favorite game was inspired by “20 questions.” We called it “the animal guessing game.”

It basically worked like this – you thought of the most unusual animal you knew of (perhaps something you’d seen on Animal Kingdom or in an animal encyclopedia) and the rest of the family would ask yes and no questions until they guessed what it was, or all agreed to being stumped.

Now, most of us would systematically narrow the field of possibilities by asking typical questions related to size, territory, habitat, skin type (fur, scale etc.) and so on. But my younger sister would always begin by asking the same question:

“Does it have fangs?”

At the time I thought she was hopelessly silly and incapable of systematic analysis. So few animals, after all, would fall into that category. Surely that wasn’t a good lead question.

But as I reflect on my sister’s perseverance on fangs, I realize that she was using an emotive hierarchy. To her, animals with fangs were so frightening, that she wanted to get it out of the way first thing – to be sure that we weren’t going to be spending time reviewing the life cycle and eating habits of animals with sharp teeth.

You know, it may seem funny, but I think that when it comes to matters of medicine some patients feel the way my sister did about the animal guessing game. They’re in unfamiliar territory, they are afraid of a real or perceived threat of a painful test or procedure, and they are internally focused on that threat to the exclusion of the big picture.

Doctors have the natural tendency to be removed from the emotional priorities of patients. We think that the patient is most interested in the evidence behind certain tests, the statistics, the technical aspects of a procedure – but sometimes as they try to comprehend the details of your informed consent, they really have one burning question:

Does it have fangs?

This post originally appeared on Dr. Val’s blog at

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2 Responses to “Informed consent & the animal guessing game”

  1. CharlieSmithMD says:

    Dr. Jones,

    Your post is a great reminder that, regardless of how knowledgeable or well trained a physician is, none of this is likely to get through unless they are also sensitive to and capable of addressing and meeting the patients needs. Baring fangs, which we often do with no conscious awareness, blocks us from effective use of our training to really help the patient.

  2. Anonymous says:

    What a wonderful story–and analogy. I too grew up in Canada. Fortunately there are few animals with fangs in that country, which is another reason why we are tolerant and patient.

    Young children (which I assume your sister was) do not differentiate as well as adults between reality and play, so the mention of an animal with fangs will stir up more unease in them than it will in an older child or adult. Sometimes, for example, you have to go with the child and show them concretely that there are no fangs around. (See? It’s safe. No fangs in your closet, under the bed, etc.)

    I believe that medical situations often cause a regression in thinking to a state where there is less differentiation between monsters and reality than the mature adult ususally has, no matter how sane and mentally healthy the patient is. I believe that this regression causes a lot of fear and apparently irrational ty. It is hard for other people, including doctors, to understand the depth of these feelings, since they are looking at the situation from the point of view of the older sister and the parents in the car game, while the patient is temporarily, against their will, in the position of your little sister.

    It is not surprising to me as a psychologist that this regression occurs, since medical situations are, if we are really honest about it, frightingly primitive: patients lose their clothes, are rendered unconscious, are cut into, have things removed from their body, are jabbed at, have pictures taken of the insides of their body, etc. Of course our adult selves are understanding and grateful for this, but the fact that it is necessary, helpful, kindly intended, and given scientific names does not entirely convince us that it might not have fangs!

    Thanks again for another wonderful post.


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